CRITICAL INCIDENT STRESS MANAGEMENT PROTOCOL
1.1 The Maryland Critical Incident Stress Management
(M.C.I.S.M.) program is based on a team approach,
consisting of mental health professionals and
peer support personnel. The M.C.I.S.M. team
provides multiple services for emergency service
workers, e.g., defusing, debriefings, referrals,
and education. These services are performed in
conjunction with fire, police, and E.M.S.
departments and providers across the state. The
coordination of the M.C.I.S.M. team is conducted
1.2 There are strong indications that more than 86%
of emergency services personnel experience some
emotional, cognitive or physical reaction after
responding to certain calls. These calls have the
potential to create a state of psychological
distress which will cause the provider to become
concerned about his or her health. It is
extremely important that when providers are
having unusual or intense reactions to a certain
call or an accumulation of calls, that the
M.C.I.S.M. team be notified. The major stressors
of emergency workers may include but are not
* Death or serious injury of a fellow
* Suicide of a fellow worker
* Multiple casualty incidents
* Death or serious injury to children
* Familiarity with the victims
* Prolonged rescue work
* Exposure to dismemberment
2.1 To provide the psychological support necessary to
ensure optimal functioning of Maryland emergency
workers and their primary support systems.
2.2 To enhance job (volunteer & career) retention
capabilities for providers and reduce the turn-
2.3 To enhance the quality of response for persons in
the State of Maryland needing emergency services.
2.4 To enhance the psychological welfare of providers
and their families.
3.1.1 Defusings are performed after the
incident and after the unit has returned
to the station. The purpose is to offer
information, support, and allow initial
ventilations of feelings. The need for a
debriefing can be established at this
3.1.2 Defusings should last only 15-30 minutes
3.2.1 Optimally debriefings are to take place
48 to 72 hours after the incident. The
debriefing process allows the providers
to express what they did, what they saw,
and how they felt. This is done in a
group forum to allow the discussion to
take place freely among the providers.
The M.C.I.S.M. team members facilitate
this discussion and provide positive feed
back when appropriate.
4.1 Feelings of anger
4.5 Blaming yourself
4.6 Unable to get good rest
5.1 The M.C.I.S.M. coordinators and their team
members should not force this concept on the
providers who are not reacting in an unusual
5.2 Providers that do not exhibit any unusual
5.3 Except in very rare situations should debriefings
be made mandatory and only in consultation with
the M.C.I.S.M. coordinator.
6. PROCEDURE TO ACTIVATE THE TEAM
6.1 The providers are to contact the M.C.I.S.M.
coordinator in their region if one has been
established. If your region does not have a
coordinator you may call SYSCOM, and a M.C.I.S.M.
representative will call you back. 1-800-648-3001
6.2 When notified, the M.C.I.S.M. Program Coordinator
contacts the Agency requesting service to assess
the specific support needs and is given a time
and place for the defusing or debriefing.
6.3 It is the responsibility of the M.C.I.S.M.
Program Coordinator to contact the appropriate
number of mental health and peer support team
members to conduct the defusing or debriefing.
Team members who live in or near the area of the
station will be called first. One of the team
members will be the team leader and be
responsible for the team.
6.4 It is imperative for the station to give the
M.C.I.S.M. Program Coordinator only ONE contact
person from the station in order to avoid any
6.5 The team leader will call the contact person of
the station to gather any additional information
and to confirm the time and place of the defusing
6.6 After the debriefing, the team leader is
responsible for contacting the station within 48
hours to assess the effectiveness of the defusing
or debriefing and to follow-up on any referrals
that were made.
7.1 All debriefing sessions are held in the strictest
7.2 All participants must agree to keep the names of
persons participating in the session and the
content of the session confidential.
7.3 Press persons are never permitted to attend a
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